Eating and drinking with acknowledged risk

Read our practical guide below for relatives and carers about food and fluid in advanced disease / severe frailty.

You can also download a PDF version of this patient information by following the link on the right.

What is comfort feeding?

Comfort feeding can help reduce risks of infection and maintain or enhance enjoyment of eating and drinking and quality of life. It’s important to know that comfort feeding may not meet all of a person’s nutritional needs.

This guide covers conditions which can affect the ability to swallow safely. People with some advanced diseases can have difficulty swallowing which can put them at risk of chest infections or pneumonia. Sometimes tube feeding may be an option instead of continuing to eat and drink by mouth. But for some people tube feeding isn’t possible, not in theirbest interests, or they’ve refused tube feeding.

This is when we may suggest eating and drinking with acknowledged risk (EDAR). It means continuing to eat and drink by mouth even though the risk might cause a chest infection or pneumonia.

What are the effects of having a swallowing difficulty?

It can cause problems with:

• chewing / swallowing food
• swallowing drinks
• keeping food and drink in the mouth
• food staying in the mouth after eating
• food or drink going down the wrong way and causing coughing
• recurrent chest infections.

Food or drink that goes down the wrong way can cause chest infections or pneumonia. Some people who have a swallowing difficulty don’t choke on food or drink even if it goes down the wrong way. This means food or drink can ‘go down the wrong way’ without anyone knowing it happened.

How can healthcare staff help?

A speech and language therapist (SLT) can help eople who develop a swallowing difficulty. They’ll give advice on the safest food and fluid textures.

The local SLT team in the community are based at Amersham Hospital.

Call 01494 323440 from Monday to Friday, 8.30am to 4.30pm.

People with swallowing difficulties may also be referred to a dietitian for nutrition advice and support. Dietitians will give advice on how to ensure the right food and fluid texture provides the nutrition needed.

Dietitians and SLTs often work closely together.

Practical advice for people with swallowing difficulties

Your relative/the person you’re caring for may need to have soft, minced, or pureed food. These textures can be safer to manage. A dietitian/SLT may advise them to have thickening drinks.

Food that is very cold, for example, chilled yoghurt can be better to swallow than lukewarm food. Also, strongly flavoured food that’s very sweet, spicy, or sharp can be better than bland
flavours.

You can buy soft and pureed frozen meals from companies including Wiltshire Farm Foods, Oakhouse Foods, and Mrs Gills. These meals are made to the textures advised by SLTs and can also help to meet nutritional needs advised by our dietitians.

Practical advice – mouth care

To improve comfort and wellbeing, good mouth care including brushing teeth and rinsing with mouthwash if possible can help lower the risk of a chest infection. Good mouth care can reduce the amount of bacteria in the mouth.

Practical advice – nutrition

Offer small amounts of food and drinks frequently during the day. Many people with a swallowing difficulty may not manage to eat or drink large amounts at one time.

You should also offer foods and drinks that you know the person with swallowing difficulties likes. Normal healthy eating guidelines, such as eating a diet low in fat and sugar, and snacking between meals  don’t apply.

For more information, search online for food first information sheets on eating well for small appetites, homemade sip feeds and fortifying food for care homes. You can also ask a dietitian or GP.

You can also search our nutrition and dietetics patient information leaflets

Practical advice – prescribed medicines

If swallowing medicines is difficult, tell the person’s GP, pharmacist, specialist nurse or community nurse. Their GP may be able to stop some medicine and change others to soluble or liquid medicines, which can be easier to swallow.

If liquid medications also need to be thickened, the pharmacist can provide advice and support.

We advise some people with a swallowing difficulty to have thickened drinks. Thickened drinks move more slowly and can make drinks easier and safer to swallow.

The GP will be asked to prescribe the thickener ‘Nestle Resource Thicken Up Clear.’ This is the thickener used in our NHS Trust. The amount of thickener needed by each person will be different but is usually at least 5 tubs (125g tub) per month.

Practical advice for people with dementia

Try to provide meals, snacks and drinks when the person is most alert. During any meal, snack or drink, the person may need reminding about the meal, snack, or drink and to swallow each mouthful.

If you’re helping someone with dementia to eat, make sure they’ve swallowed the last mouthful before offering another.

Use gentle, physical prompts to help the person to eat by themself, for example try putting the fork, spoon or cup in the person’s hand and gently guiding it to their mouth.

Try to keep the place where the person’s eating as calm and free from distraction as you can.

Some people with dementia develop a taste for very sweet foods and may prefer those to savoury foods.

If a person with dementia wakes often during the night, it may be because of hunger. Try to keep some small snacks at hand that they can manage, for example a small tub of custard or smooth yoghurt, soft crisps such as Quavers.

Advance care planning

Many people worry about how they’ll be cared for as they approach the end of their lives. Some may have read or heard stories in the media which make them anxious or worried they may not be given food or drinks when they feel hungry or thirsty.

Concerns like these are normal and giving some thought to what care or treatment you would accept can help reduce these concerns. Thinking and talking about your wishes for how you’re cared
for in the final months of your life is called advance care planning.

It’s important to check with relatives and/or family if there’s a lasting power of attorney set up and in place for health and welfare.

People usually carry out advance planning because they have a condition that is expected to get worse. It may mean they can’t make decisions or communicate their decisions in the future. Talk to your GP about putting this in place. Anyone can plan for their future care, whether they’re approaching the end of life or not.

Advance care planning can let people know your wishes and feelings, while you can tell people.

End of life (palliative feeding for comfort)

People may worry that as a person approaches the end of their life and their food and fluid intake reduce, that the person will feel hungry and thirsty. But often the person may not feel hungry or thirsty, and this is a natural part of the body slowing down.

Frequent mouth care can help to reduce feelings of thirst. Offer frequent sips of fluid and help with cleaning teeth or dentures.

If the person’s hungry, the nutrition and swallowing advice above should help you.

Offer the person whatever they want to eat and drink as long as it doesn’t cause distress or discomfort.

Find out more about care in the last few days of life at home

How can I help reduce healthcare associated infections?

Infection prevention and control is important to the wellbeing of our patients so we have procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections.

You, and anyone visiting you, must use the hand sanitiser available at the entrance to every ward before coming in and after you leave. You may need to wash your hands at the sink using soap and water. Hand sanitisers are not suitable for dealing with patients who have symptoms of diarrhoea.

More help or advice

Contact our patient advice and liaison service (PALS) on 01296 316042 or bht.pals@nhs.net